(Vox) – Death tolls are the primary way we understand the impact of a disaster. And for nearly two weeks after Hurricane Maria hit Puerto Rico, as a humanitarian crisis was intensifying, the death toll was frozen at 16.

“Sixteen people certified,” Trump said on 3 October 2017 during his visit to the island, repeating a figure confirmed by the territory’s governor. "Everybody watching can really be very proud of what's taken place in Puerto Rico."

It was a moment that crystallized two conflicting narratives about the Puerto Rico disaster. The first one, from the federal government and Puerto Rico’s governor, is of a disaster that’s been managed well, with lives being saved and hospitals getting back up and running.

Lives surely have been saved in the response. But images and reports from the ground tell a story of people, cut off from basic supplies and health care, dying. They tell of hospitals running out of medication and fuel for their generators and struggling to keep up with the “avalanche of patients that came after the hurricane,” as one journalist put it.

The death toll from the hurricane isnow up to 45, according to Gov. Ricardo Rosselló. But 90 percent of the 3.4 million American citizens on the island still don’t have power, and 35 percent still don’t have water to drink or bathe in. And given how deadly power outages can be, 45 deaths seems low, according to disaster experts.

At Vox, we decided to compare what the government has been saying with other reports of deaths from the ground. We searched Google News for reports of deaths in English and Spanish media from Puerto Rico since Hurricane Maria. We found reports of a total of 81 deaths linked directly or indirectly to the hurricane. Of those, 45 were the deaths certified by the government. The remaining 36 deaths were confirmed by local public officials or funeral directors, according to the reports. We also found another 450 reported deaths, most of causes still unknown, and reports of at least 69 people still missing. […]

The situation on the ground remains life-threatening in some areas. And reporters and first responders are continuing to paint a much more aggressive picture about life and death on the island.

"It's horrible, it's horrible. It's a nightmare," a resident of the town of Atlaya told CBS on Tuesday. "There's barely any drinking water, not even in supermarkets; my fear is for my kids," another said. […]

There are reports of another 450 who died of undetermined causes

News reports cite the deaths of more than 450 additional people since the hurricane, and 69 people have been reported missing. The additional deaths could be people who died as a direct result of the hurricane, or indirectly from the hurricane, or people who would have died even without the storm. For example, we found a report of one person who died because she didn't have enough oxygen tanks — this would count as an indirect death.

Here’s how we came up with figure of at least 450:

An NPR reporter shadowed doctors at the Pavia Arecibo Hospital in Arecibo this week, where the lack of air conditioning was exacerbating patients' health problems. The hospital administrator told NPR there are 49 bodies at the hospital morgue from deaths after the storm. It's unclear how many were directly or indirectly linked to the storm.

A reporter from the Los Angeles Times recently visited Lajas — a rural town on the southwestern side of the island — where elderly people can't get access to enough oxygen and insulin. The local funeral director said that at least 100 people had died in the area within three days of the storm’s passage, which is 50 percent higher than the area's normal death rate.

Puerto Rico's medical examiners' office doesn't have enough staff to examine the cadavers or enough room to store them. Some 350 bodies were said to be at the Institute of Forensic Science, but it wasn’t clear how many were there before the storm.

A reporter for the Center for Investigative Reporting in Puerto Rico spoke to doctors in half a dozen hospitals who said bodies are piling up at the morgues of the 69 hospitals in Puerto Rico. The majority of the hospital morgues that provided information are at full capacity. […]

CNN medical correspondent Sanjay Gupta also described his fears of a much higher death toll in an essay he wrote after visiting Puerto Rico and meeting many very sick people. “There may be tens of thousands of hardy people who survived the hurricane and are now struggling to stay alive in its aftermath,” he wrote. “They are teetering on the edge, with hardly any reserve.” [more]